Healthcare Provider Details

I. General information

NPI: 1396122776
Provider Name (Legal Business Name): SACRED PASSAGE MIDWIFERY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/05/2015
Last Update Date: 05/05/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

245 TUNE DRIVE
EL PRADO NM
87529-1092
US

IV. Provider business mailing address

PO BOX 1092
EL PRADO NM
87529-1092
US

V. Phone/Fax

Practice location:
  • Phone: 575-770-5253
  • Fax:
Mailing address:
  • Phone: 575-770-5253
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175M00000X
TaxonomyLay Midwife
License Number96367R
License Number StateNM

VIII. Authorized Official

Name: JULIE SCHOCHET
Title or Position: OWNER
Credential: LM, CPM
Phone: 575-770-5253